Killer facts

PATIENTS once meekly accepted the advice of their family doctor. But these days, many of them visit the surgery armed with information about their ailments, which has been plucked resourcefully from the Internet. Last week, those keen to influence their medical fates received more ammunition: a study was published which compares mortality rates at hospital trusts across the country.

The study, by Sir Brian Jarman of Imperial College, indicates a wide variation in death rates, even allowing for the different types of patients and conditions which individual hospitals treat. In the hospital with the highest level of mortality, 17 people die for every ten in the one with the lowest rate. The study indicates a north-south mortality divide, with fewer deaths in southern hospitals, and a rough and unsurprising correlation between mortality and the number of doctors, both inside and outside hospitals.

Research like Sir Brian's answers a growing demand for knowledge, and helps to make the National Health Service more transparent. The government has itself promised to introduce annual report cards for hospitals, and clear indicators of which hospitals are best, and which are not. That will provide patients with the sort of information which would be useful to them if they could act on it. The trouble is that many of them will find it difficult to, partly because some have only one local hospital.

Ministers hope that failing hospitals will be chastised into improvement by the publication of performance indicators, and that the question of choice will be made redundant by universal excellence. Peter Lilley, a former cabinet minister and author of a recent pamphlet about patient choice, points to evidence from New York, which suggests that merely publishing data can raise standards. That may happen in Britain, but in the short term, some patients face the prospect of being treated in hospitals that are officially sub-standard.

But the fundamental question the research raises is whether, given enough information and the right policies, consumers should be able to treat health-care as if it were just another product in the market place. The publication of more and accurate performance data is desirable, but most laymen will still not be equipped to decide, without the advice of their doctor, where they should be treated and by whom. Patients may always need some degree of old-fashioned paternalism.